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Epilepsia Mar 2012This critical review refers to the new report on terminology and concepts for the organization of epilepsies by the Commission of the International League Against... (Review)
Review
This critical review refers to the new report on terminology and concepts for the organization of epilepsies by the Commission of the International League Against Epilepsy (ILAE). It is unfortunate that most of the proposals in the Commission's report are modified interpretations and nomenclature of previous ILAE classifications; new terms are not better than the old ones, and recent advances have not been incorporated. Hence, the new ILAE report met with considerable dissatisfaction from several expert epileptologists. The Commission abandoned (1) the disease-syndrome distinction, although "disease" is generally differentiated from "syndrome" in most medical texts as well as in the ILAE classification itself; (2) the distinction of "generalized" and "focal" for epileptic syndromes, despite maintaining this distinction for epileptic seizures and despite the fact that most epileptic syndromes manifest exclusively either with generalized or focal epileptic seizures; (4) the terms "idiopathic,""symptomatic," and "cryptogenic," although these terms have been well defined in the previous ILAE classifications; reiterating their true meaning would be sufficient. Genetic epilepsy could be a new category and (5) the designation of "benign" epilepsies, despite the recommendations of experts at the Monreale workshop. In addition, the Commission proposed that "age at onset" be used as a primary dimension for organizing the epilepsies. However, (a) this runs counter to classification efforts of other diseases in medicine and neurology; (b) syndromes that are likely to be linked together on the basis of electroclinical (and often genetic) evidence are now separated and intermixed with a number of heterogeneous epilepsies; and (c) a considerable number of epileptic syndromes have a wide range of age at onset from childhood to adulthood. Furthermore, epilepsy syndromes were given by name only, without definition; thus we remain dependent on previous ILAE definitions, which are often broad and imprecise. The ILAE should commission consensus of opinion from experts in specific fields in order to define each syndrome. Areas of certainties and uncertainties and of agreements and disagreements should be identified and explained. This approach may be the only way toward achieving a scientifically sound and clinically meaningful organizational system for the epileptic seizures and the epilepsies-a process that would incorporate the tremendous advances in our field and would be accepted by the wider community of clinicians and scientists.
Topics: Epilepsy; Expert Testimony; Humans; International Classification of Diseases; Practice Guidelines as Topic; Societies, Medical; Syndrome; Terminology as Topic
PubMed: 22242702
DOI: 10.1111/j.1528-1167.2011.03381.x -
Bulletin of the World Health... Jan 2022To identify and compare antimicrobial treatment guidelines from African Union (AU) Member States.
OBJECTIVE
To identify and compare antimicrobial treatment guidelines from African Union (AU) Member States.
METHODS
We reviewed national government agency and public health institutes' websites and communicated with country or regional focal points to identify existing treatment guidelines from AU Member States. We included guidelines if they contained disease-, syndrome- or pathogen-specific treatment recommendations and if those recommendations included antimicrobial name or class, dosage and therapy duration. The scope of the review was limited to infections and clinical syndromes that often have a bacterial cause. We assessed treatment guidelines for alignment with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. We compared treatment recommendations for various common bacterial infections or clinical syndromes described across national guidelines and those described in three World Health Organization guidelines.
FINDINGS
We identified 31 treatment guidelines from 20 of the 55 (36%) AU Member States; several countries had more than one treatment guideline that met our inclusion criteria. Fifteen (48%) guidelines from 10 countries have been published or updated since 2015. Methods used to develop the guidelines were not well described. No guidelines were developed according to the GRADE approach. Antimicrobial selection, dosage and duration of recommended therapies varied widely across guidelines for all infections and syndromes.
CONCLUSION
AU Member States lack antimicrobial treatment guidelines that meet internationally accepted methods and that draw from local evidence about disease burden and antimicrobial susceptibility.
Topics: African Union; Anti-Bacterial Agents; Humans
PubMed: 35017757
DOI: 10.2471/BLT.21.286689 -
Journal of the American Pharmacists... 2021Pharmacists are among the nation's most accessible and underused health professionals. Within their scope of practice, pharmacists can prescribe and administer vaccines,...
BACKGROUND
Pharmacists are among the nation's most accessible and underused health professionals. Within their scope of practice, pharmacists can prescribe and administer vaccines, conduct point-of-care testing, and address drug shortages through therapeutic substitutions.
OBJECTIVES
To better use pharmacists as first responders to coronavirus disease 2019 (COVID-19), we conducted a needs and capacity assessment to (1) determine individual commitment to provide COVID-19 testing and management services, (2) identify resources required to provide these services, and (3) help prioritize unmet community needs that could be addressed by pharmacists.
METHODS
In March 2020, pharmacists and student pharmacists within the Alaska Pharmacist Association worked to tailor, administer, and evaluate results from a 10-question survey, including demographics (respondent name, ZIP Code, cell phone, and alternate e-mail). The survey was developed on the basis of published COVID-19 guidelines, Centers for Disease Control and Prevention COVID-19 screening and management guidelines, National Association of Boards of Pharmacy guidance, and joint policy recommendation from pharmacy organizations.
RESULTS
Pharmacies are located in the areas of greatest COVID-19 need in Alaska. Pharmacists are willing and interested in providing support. Approximately 63% of the pharmacists who completed the survey indicated that they were interested in providing COVID-19 nasal testing, 60% were interested in conducting COVID-19 antibody testing, and 93% were interested in prescribing and administering immunizations for COVID-19, as available. When asked about resources needed to enable pharmacists to prescribe antiviral therapy, 37% of the pharmacists indicated they needed additional education or training, and 39% required access to technology to bill and document provided services.
CONCLUSION
The primary barrier to pharmacists augmenting the current COVID-19 response is an inability to cover the costs of providing these health services. Pharmacists in Alaska are ready to meet COVID-19-related clinical needs if public and private insurers and legislators can help address the barriers to service sustainability.
Topics: Alaska; COVID-19; COVID-19 Testing; COVID-19 Vaccines; Emergency Responders; Humans; Pharmaceutical Services; Pharmacists; Professional Role; Students, Pharmacy; Surveys and Questionnaires
PubMed: 33036935
DOI: 10.1016/j.japh.2020.09.008 -
BMC Medical Informatics and Decision... Dec 2021Semantic annotators and Natural Language Processing (NLP) methods for Named Entity Recognition and Linking (NER+L) require plenty of training and test data, especially...
BACKGROUND
Semantic annotators and Natural Language Processing (NLP) methods for Named Entity Recognition and Linking (NER+L) require plenty of training and test data, especially in the biomedical domain. Despite the abundance of unstructured biomedical data, the lack of richly annotated biomedical datasets poses hindrances to the further development of NER+L algorithms for any effective secondary use. In addition, manual annotation of biomedical documents performed by physicians and experts is a costly and time-consuming task. To support, organize and speed up the annotation process, we introduce MedTAG, a collaborative biomedical annotation tool that is open-source, platform-independent, and free to use/distribute.
RESULTS
We present the main features of MedTAG and how it has been employed in the histopathology domain by physicians and experts to annotate more than seven thousand clinical reports manually. We compare MedTAG with a set of well-established biomedical annotation tools, including BioQRator, ezTag, MyMiner, and tagtog, comparing their pros and cons with those of MedTag. We highlight that MedTAG is one of the very few open-source tools provided with an open license and a straightforward installation procedure supporting cross-platform use.
CONCLUSIONS
MedTAG has been designed according to five requirements (i.e. available, distributable, installable, workable and schematic) defined in a recent extensive review of manual annotation tools. Moreover, MedTAG satisfies 20 over 22 criteria specified in the same study.
Topics: Algorithms; Humans; Names; Natural Language Processing; Semantics
PubMed: 34922517
DOI: 10.1186/s12911-021-01706-4 -
Journal of Public Health (Oxford,... Jun 2018
Topics: Anonyms and Pseudonyms; Confidentiality; Humans; Medical Record Linkage; United Kingdom
PubMed: 29767778
DOI: 10.1093/pubmed/fdy083 -
Drug Safety Mar 2024In refining drug safety signals, defining the object of study is crucial. While research has explored the effect of different event definitions, drug definition is often...
INTRODUCTION
In refining drug safety signals, defining the object of study is crucial. While research has explored the effect of different event definitions, drug definition is often overlooked. The US FDA Adverse Event Reporting System (FAERS) records drug names as free text, necessitating mapping to active ingredients. Although pre-mapped databases exist, the subjectivity and lack of transparency of the mapping process lead to a loss of control over the object of study.
OBJECTIVE
We implemented the DiAna dictionary, systematically mapping individual free-text instances to their corresponding active ingredients and linking them to the World Health Organization Anatomical Therapeutic Chemical (WHO-ATC) classification.
METHODS
We retrieved all drug names reported to the FAERS (2004-December 2022). Using existing vocabularies and string editing, we automatically mapped free text to ingredients. We manually revised the mapping and linked it to the ATC classification.
RESULTS
We retrieved 18,151,842 reports, with 74,143,411 drug entries. We manually checked the first 14,832 terms, up to terms occurring over 200 times (96.88% of total drug entries), to 6282 unique active ingredients. Automatic unchecked translations extend the standardization to 346,854 terms (98.94%). The DiAna dictionary showed a higher sensitivity compared with RxNorm alone, particularly for specific drugs (e.g., rimegepant, adapalene, drospirenone, umeclidinium). The most prominent drug classes in the FAERS were immunomodulating (37.40%) and neurologic drugs (29.19%).
CONCLUSION
The DiAna dictionary, as a dynamic open-source tool, provides transparency and flexibility, enabling researchers to actively shape drug definitions during the mapping phase. This empowerment enhances accuracy, reproducibility, and interpretability of results.
Topics: United States; Humans; Adverse Drug Reaction Reporting Systems; Drug-Related Side Effects and Adverse Reactions; Reproducibility of Results; Software; United States Food and Drug Administration
PubMed: 38175395
DOI: 10.1007/s40264-023-01391-4 -
BMC Medical Ethics Jun 2023The US Food and Drug Administration (FDA) regulates goods accounting for 20% of US consumers' total expenditure. The agency's potential susceptibility to corporate...
BACKGROUND
The US Food and Drug Administration (FDA) regulates goods accounting for 20% of US consumers' total expenditure. The agency's potential susceptibility to corporate lobbying and political influence may adversely affect the its abilities to fulfill its duties as a vital federal agency. This study assesses whether the FDA's product recall classifications in recall scenarios are influenced by firms' lobbying activities.
METHODS
The universe of all FDA recalls between 2012 and 2019 is obtained from the FDA's website. Firm names are matched to federal-level lobbying data obtained from the Center for Responsive Politics - a non-profit and nonpartisan organization that tracks lobbying expenditures and campaign contributions. Analyses are conducted using ordinary-least-squares regressions, in which the dependent variable is recall classification and independent variables are three different measures of firms' lobbying activities in the one year prior to the recall.
RESULTS
Firms that engage in lobbying appear more likely to receive favourable classifications from the FDA. When examining the above results by product type, we find that classification of food recalls seems to be subject to lobbying influence, but the same does not appear to be true for drug and device recalls. Evidence is consistent with the conjecture that the distinction between medical and food firms may be a result of medical firms targeting lobbying efforts at FDA approvals, rather than recalls.
CONCLUSIONS
Between 2012 and 2019, the FDA's product recall classifications seem to be significantly influenced by firms' lobbying activities. Lobbying firms appear to have received more favorable (i.e., less severe) recall classifications compared to non-lobbying firms.
Topics: Humans; United States; Pharmaceutical Preparations; Lobbying; Politics; United States Food and Drug Administration
PubMed: 37340417
DOI: 10.1186/s12910-023-00921-0 -
Journal of Stroke May 2013In the United States (US) stroke care has undergone a remarkable transformation in the past decades at several levels. At the clinical level, randomized trials have... (Review)
Review
In the United States (US) stroke care has undergone a remarkable transformation in the past decades at several levels. At the clinical level, randomized trials have paved the way for many new stroke preventives, and recently, several new mechanical clot retrieval devices for acute stroke treatment have been cleared for use in practice by the US Federal Drug Administration. Furthermore, in the mid 1990s we witnessed regulatory approval of intravenous recombinant tissue plasminogen activator for administration in acute ischemic stroke. In the domain of organization of medical care and delivery of health services, stroke has transitioned from a disease dominated by neurologic consultation services only to one managed by vascular neurologists in geographical stroke units, stroke teams and care pathways, primary stroke center certification according to The Joint Commission, and most recently comprehensive stroke center designation under the aegis of The Joint Commission. Many organizations in the US have been involved to enhance stroke care. To name a few, the American Heart Association/American Stroke Association, Brain Attack Coalition, and National Stroke Association have been on the forefront of this movement. Additionally, governmental initiatives by the US Centers for Disease Control and Prevention and legislative initiatives such as the Paul Coverdell National Acute Stroke Registry program have paved the way to focus on stroke prevention, acute treatment and quality improvement. In this invited review, we discuss a brief history of organized stroke care in the United States, evidence to support the value of primary and comprehensive stroke centers, and the certification criteria and process to become a primary or comprehensive stroke center.
PubMed: 24324943
DOI: 10.5853/jos.2013.15.2.78 -
Epilepsia Dec 2011The International League Against Epilepsy (ILAE) standardized classification and terminology for "epileptic seizures" of 1981 and "epilepsies and epileptic syndromes" of... (Review)
Review
The International League Against Epilepsy (ILAE) standardized classification and terminology for "epileptic seizures" of 1981 and "epilepsies and epileptic syndromes" of 1989 provide a fundamental framework for organizing and differentiating the epilepsies. However, a revision of these classifications is mandated by recent major technologic and scientific advances. Since 1997, the relevant ILAE Commissions have made significant efforts to achieve better and internationally uniform classifications as reflected in their reports of 2001, 2006, and 2010. Their initial aim to construct a "new scientific classification from application of methods used in biology that determines separate species and natural classes" proved elusive and, therefore, the last Commission in their report of 2010 confined their revisions to "new terminology and concepts" instead of "proposing a new classification (in the sense of organization) of epilepsies." It is unfortunate that most of the proposals in this report are modified interpretations and nomenclature of previous ILAE classifications; new terms are not better than the old ones, and recent advances have not been incorporated. Hence, the new ILAE report met with considerable protest from several expert epileptologists. This critical review refers mainly to the epileptic seizures, the classification of which may be an easier and less controversial task in the ILAE revisions. A revised classification should incorporate advanced knowledge of seizure pathophysiology, and clinical, interictal, and ictal manifestations. Such an attempt was made and detailed in the 2006 report of the ILAE Classification Core Group. However, these changes were largely discarded in the new ILAE report of 2010, without justification. This is inexplicable considering that the scientific advances that were available to the two Commissions were the same or had improved between 2006 and 2010. Of major concern is that "No specific classification is recommended for focal seizures which should be described according to their manifestations." Such a proposition defies the essence and the principle of any classification that requires an organization and a common language for communication. Free text descriptions are fine in a manual of differential diagnosis but not as a classification system. Another striking weakness is that even the accepted types of epileptic seizure are listed by name only, without defining them. The result is avoidable confusion. Furthermore, the report fails to consider reflex epileptic seizures. Status epilepticus is the most conspicuous omission despite immense advances of our understanding of it and its relevance on the classification. It appears that the new ILAE report does not fulfill its intent to improve the previous classifications and it may be premature to submit anything similar to this for approval by the ILAE General Assembly. The ILAE Commission could benefit by asking experts in basic and clinical science to provide a concise statement in their field of expertise as, for example, what are focal, myoclonic, or absence seizures, and their subtypes, their manifestations, and their possible pathophysiology. Areas of certainties and uncertainties, agreements and disagreements should be identified and stated clearly, with documentation of the reasons for it. Probably this is the only way forward for a truly scientific, sound, and clinically meaningful organizational system for the epileptic seizures and the epilepsies.
Topics: Epilepsy; Humans; International Agencies; Terminology as Topic
PubMed: 22004554
DOI: 10.1111/j.1528-1167.2011.03288.x -
Sante Mentale Au Quebec 2015The organization called "Les Impatients" was founded in 1992. Using a unique model, Les Impatients welcomes those with mental health issues who would like to express...
The organization called "Les Impatients" was founded in 1992. Using a unique model, Les Impatients welcomes those with mental health issues who would like to express themselves through art. Les Impatients offers free creative workshops and encourages exchanges with the community through the sharing of its participants' creations. The name Les Impatients reinforces the idea that the organization does not consider those attending its workshops as patients, but rather creators who are eager to heal, develop their craft and find their place in society. The participants contribute to the collective objective of breaking down the stigma that surrounds mental illness.Les Impatients collaborates with various mental health organizations in Quebec, such as the Institut universitaire en santé mentale de Montréal (IUSMM) affiliated to the Université de Montréal, Douglas Mental Health University Institute (DMHUI), the Centre de santé et services sociaux Drummond (CSSS Drummond) and the Centre de santé et services sociaux Pierre-Boucher (CSSS Pierre-Boucher). Les Impatients offers more than 48 workshops in eight different locations to around 450 participants each week.Dissemination activities, remarkable events, original projects: Les Impatients stands out through its realizations. Examples are exhibitions, collections of love letters, comic books, CD, concerts, and reading nights. The organization's originality resides in the exploration of the links between the work of the participants and that of professional artists. An illustration of this interest is the annual Parle-moi d'amour auction-exhibition, which has been one of Les Impatients' major events since 1999.As part of its mission, Les Impatients conserves the works of art created by the participants during the workshops. Its collection includes more than 15,000 works of art from Les Impatients as well as pieces donated by collectors of unconventional art, commonly known as "art brut" or "outsider art". The Collection is characterized by its scientific and artistic potential as well as its connection with the art brut/outsider art movement. That makes it an exciting endeavour for the world of art and social sciences.Les Impatients workshops are appreciated by the participants because they improve self-esteem, stimulate creativity and curiosity, break isolation, contribute to develop a sense of belonging and reduce both the frequency and the length of hospitalization. For these reasons and many more, many participants have reported the positive impacts of their involvement in the arts on their recovery. The innovative activities can also be seen as enhancing the patients' recovery process.Pioneers in the field of recovery, Les Impatients is a forum where the participants, their loved ones, the team, the artists and the community can meet and exchange. Those encounters constitute great opportunities to break the stigma that surrounds mental illness, one of Les Impatients' core objectives.
Topics: Art; Community Mental Health Services; Community-Institutional Relations; Humans; Mental Disorders; Organizations, Nonprofit; Quebec
PubMed: 26559221
DOI: No ID Found